Strategy

Our clinical team provides independent and unbiased clinical decisions to members and plans. Our focus is to always provide:

The Right Drug

For the Right Patient

At the Right Time

Fully-Staffed Call Center

We offer full-service call center support. Including physician phone calls as required by our clients. PA Logic’s full-service call center can augment the client’s current call center operations, or provide additional support as needed. 

Prior Authorization Activities

Our clinical team has many years of experience processing many types of prior authorizations, to include: 

Traditional PA Edits

Medical Drugs

Specialty Drugs

Cost Overrides

Appeals Reviews

Interventions 

Multiple PA Submission Options

Prior Authorization requests may be made via secure webform, ePA, fax, phone, or US Mail.

Web PA Processing Application

The PA Logic system is accessed via the web through secure access to a hosted environment hosted in Microsoft Azure. This PA Logic software platform does not require special servers, requiring only a secure connection to the client’s devices or system.

Implementation and Operational Support

Our implementation team ensures the PA Logic platform is configured appropriately to meet a client’s unique needs. Account Management will continue to work with clients after go-live to ensure the continued success of the client’s pharmacy management program.  

Programmable PA Timers

Timers can be associated with the client’s specific lines of business. These timers give visual reminders to PAL’s clinical staff of the processing time remaining to meet regulatory or plan compliance.

Formulary and Criteria Optimization

PAL’s clinical team has optimized over 200 clinical criteria sets for use with PA Logic. Our clinicians meet regularly in an internal P & T committee to update the criteria library.

ePA Enabled

The PA Logic system is Surescripts Enabled and can send and receive prior authorization requests using the NCPDP 4-Part process.

Audit and Appeals

The PA Logic system includes a full audit trail for transactions in the system. The Appeals Module tracks the entire appeal request and incorporates the information within the full PA record.

Robust Reporting

PA Logic includes sophisticated data analytics using the Tableau Business Intelligence tool. This enables clients to have a real-time look into productivity, drug utilization, and trending patterns. PAL’s reporting tool offers the client the ability to extract data as required and in multiple formats.

Access to Our Staff

Clients are encouraged to work directly with PA Logic staff to setup and configure the system to meet their specific needs.  Post go-live, our support team continues to work with the client on regular content updates to formulary, decision trees, letter and fax template, etc. ensuring the system continues to meet client needs.

Customizable Fax and Mail Templates

Letter and fax templates may be customized to meet branding guidelines and required rationale for a given PA’s disposition. 

Print and Mail Services

Our dedicated print and mail team delivers mail to the USPS every 2 hours.  Letter and fax templates can be customized to meet branding guidelines and will include rationale that has been approved by the plan. 

NCQA Compliant

PA Logic Solutions is NCQA Compliant in Utilization Management. PA Logic Solutions was awarded this certification with a score of 99.05%. 

Interventions

PAL offers customized Intervention programs. Our clients have realized significant cost savings through these programs. There is a wide range of Intervention types and activities that PAL offers.

Provider Outreach & Education Programs

PA Logic Solutions offers academic detailing along with provider education and outreach programs.